HIV-tuberculosis coinfection
From IDWiki
Management
Latent Tuberculosis Infection
- When using isoniazid monotherapy, can use any HIV medication
- When using rifampin or rifapentine, need to check for drug-drug interactions
Active Tuberculosis
- Rifampin is a core antimicrobial for tuberculosis and should be given priority in drug-drug interactions
- NRTIs do not require any adjustment, INSTIs and NRTIs often need dose adjustment, and PIs are usually contraindicated
- Regimens that minimize drug-drug interactions:
- Efavirenz 600 mg PO daily or raltegravir 400 mg PO bid, combined with abacavir/lamivudine or tenofovir disoproxil fumarate/emtricitabine
- Tenofovir disoproxil fumarate/emtricitabine + efavirenz
- Tenofovir disoproxil fumarate/emtricitabine + double raltegravir
- Abacavir/lamivudine with BID dolutegravir
- Tenofovir alafenamide may or may not be affected by rifampin
- Timing
- Start TB treatment immediately
- If not already on HIV treatment:
- CD4 count <50 cells/mm3: start HIV treatment as soon as possible, and within 2 weeks of TB treatment
- CD4 count ≥50 cells/mm3: start HIV treatment within 8 weeks of TB treatment
- Pregnancy, regardless of CD4: start as soon as feasible, to prevent transmission
- With tuberculous meningitis, generally defer to 8 weeks, or monitor closely when starting early